Lisa A. Marsch's research while affiliated with Dartmouth College and other places
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Publications (260)
Introduction:
Indigenous people experience health disparities, including higher rates of substance use disorders (SUDs). Digital therapeutics are a growing platform for treatment services and have the potential to expand access to culturally responsive interventions for Indigenous people. As one of the first randomized controlled trials for SUDs f...
BACKGROUND
Although tobacco use has significantly declined in the general population, traditional tobacco use treatment uptake and success rates remain disproportionately low among people who identify as African American/Black, Hispanic/Latina/o, and American Indian/Alaskan Native (AA/B, H/L and AI/AN). Technology-based interventions (TBIs) for tob...
Background:
Multiple digital data sources can capture moment-to-moment information to advance a robust understanding of opioid use disorder (OUD) behavior, ultimately creating a digital phenotype for each patient. This information can lead to individualized interventions to improve treatment for OUD.
Objective:
The aim is to examine patient enga...
Study objective:
We hypothesized that implementation facilitation would enable us to rapidly and effectively implement emergency department (ED)-initiated buprenorphine programs in rural and urban settings with high-need, limited resources and dissimilar staffing structures.
Methods:
This multicenter implementation study employed implementation...
Background:
National opioid-related overdose fatalities totaled 650,000 from 1999 to 2021. Some of the highest rates occurred in New Hampshire, where 40% of the population lives rurally. Medications for opioid use disorder (MOUD; methadone, buprenorphine, and naltrexone) have demonstrated effectiveness in reducing opioid overdose and mortality. Me...
Purpose:
The use of telemedicine (TM) has accelerated in recent years, yet research on the implementation and effectiveness of TM-delivered medication treatment for opioid use disorder (MOUD) has been limited. This study investigated the feasibility of implementing a care coordination model involving MOUD delivered via an external TM provider for...
Objective:
Evaluation of the effectiveness of integration of depression and alcohol use disorder care into primary health care in low- and middle-income countries (LMICs) is limited. The authors aimed to quantify the effectiveness of integrating mental health care into primary care by examining depression and alcohol use disorder outcomes. The stu...
BACKGROUND
Multiple digital data sources can capture moment-to-moment information to advance a robust understanding of opioid use disorder (OUD) behavior, ultimately creating a digital phenotype for each patient. This information can lead to individualized interventions to improve treatment for OUD.
OBJECTIVE
The aim is to examine patient engageme...
Mental health and substance use disorders are highly prevalent and are the leading cause of global disease burden worldwide. Nevertheless, most persons with mental health or substance use disorders do not receive care. Prominent barriers to traditional care include (1) stigma, (2) lack of culturally competent treatments, (3) prohibitively high cost...
While the COVID-19 pandemic disrupted healthcare delivery everywhere, persons with carceral system involvement and opioid use disorder (OUD) were disproportionately impacted and vulnerable to severe COVID-associated illness. Carceral settings and community treatment programs (CTPs) rapidly developed protocols to sustain healthcare delivery while re...
Digital Therapeutics for Mental Health and Addiction: The State of the Science and Vision for the Future presents the foundations of digital therapeutics with a broad audience in mind, ranging from bioengineers and computer scientists to those in psychology, psychiatry and social work. Sections cover cutting-edge advancements in the field, offering...
Introduction
The COVID-19 pandemic has had an impact both in general and mental healthcare, challenged the health systems worldwide, and affected their capacity to deliver essential health services. We aimed to describe perceived changes in ease of access to general and mental healthcare among patients with a diagnosis of depression and/or unhealth...
Opioid Overdose Network is an effort to generalize and adapt an existing research data network, the Accrual to Clinical Trials (ACT) Network, to support design of trials for survivors of opioid overdoses presenting to emergency departments (ED). Four institutions (Medical University of South Carolina [MUSC], Dartmouth Medical School [DMS], Universi...
Background
Existing implementation measures developed in high-income countries may have limited appropriateness for use within low- and middle-income countries (LMIC). In response, researchers at Johns Hopkins University began developing the Mental Health Implementation Science Tools (mhIST) in 2013 to assess priority implementation determinants an...
Background:
Self-regulation refers to a person’s ability to manage their cognitive, emotional, and behavioral processes to achieve long-term goals. Most prior research has examined self-regulation at the individual level; however, individual-level assessments do not allow the examination of dynamic patterns of intraindividual variability in self-re...
Despite federal guidelines, many adolescents and emerging adults are not offered HIV testing by their healthcare providers. As such, many—including those who may be at high-risk for contracting HIV given their sexual and/or substance use risk—are not routinely tested. The current study examines sexual risk and substance use among emergency departme...
Introduction:
Across the U.S., the prevalence of opioid use disorder (OUD) and the rates of opioid overdoses have risen precipitously in recent years. Several effective medications for OUD (MOUD) exist and have been shown to be life-saving. A large volume of research has identified a confluence of factors that predict attrition and continued subst...
Health care delivery is undergoing a rapid change from traditional processes toward the use of digital health interventions and personalized medicine. This movement has been accelerated by the COVID-19 crisis as a response to the need to guarantee access to health care services while reducing the risk of contagion. Digital health scale-up is now al...
Introduction:
Self-regulation has been implicated in health risk behaviors and is a target of many health behavior interventions. Despite most prior research focusing on self-regulation as an individual-level trait, we hypothesize that self-regulation is a time-varying mechanism of health and risk behavior that may be influenced by momentary conte...
Background
: Increasing buprenorphine/naloxone (B/N) access for opioid use disorder (OUD) is essential yet ensuring adherence and preventing diversion remains challenging. This study examines the feasibility, usability, and acceptability of MySafeRx, a mobile platform integrating motivational coaching, adherence monitoring, and electronic dispensin...
Importance:
Emergency departments (EDs) are increasingly initiating treatment for patients with untreated opioid use disorder (OUD) and linking them to ongoing addiction care. To our knowledge, patient perspectives related to their ED visit have not been characterized and may influence their access to and interest in OUD treatment.
Objective:
To...
Objective
Drug overdoses are the leading cause of death in the United States for those under 50 years of age, and New Hampshire has been disproportionately affected, resulting in increased encounters with the emergency response system. The ensuing impact on emergency personnel has received little attention. The present study aimed to explore the ex...
BACKGROUND
Self-regulation refers to a person’s ability to manage their cognitive, emotional, and behavioral processes to achieve long-term goals. Most prior research has examined self-regulation at the individual-level, but individual-level assessments does not allow examining dynamic patterns of intra-individual variability in self-regulation and...
Background
Social media sites, dating apps, and information search sites have been used to reach individuals at high risk for HIV infection. However, it is not clear which platform is the most efficient in promoting home HIV self-testing, given that the users of various platforms may have different characteristics that impact their readiness for HI...
BACKGROUND
Social media sites, dating applications (apps), and informational search sites have been used to reach individuals put at-risk for Human Immunodeficiency Virus (HIV) infection. However, it is not clear which type of site is the most efficient in promoting home HIV self-testing, given that the users of various platforms may have different...
Background
Increasingly, treatment for opioid use disorder (OUD) is offered in integrated treatment models addressing both substance use and other health conditions within the same system. This often includes offering medications for OUD in general medical settings. It remains uncertain whether integrated OUD treatment models are preferred to non-i...
Telemedicine (TM) enabled by digital health technologies to provide medical services has been considered a key solution to increasing health care access in rural communities. With the immediate need for remote care due to the COVID-19 pandemic, many health care systems have rapidly incorporated digital technologies to support the delivery of remote...
Background
For many reasons, the emergency department (ED) is a critical venue to initiate OUD interventions. The prevailing culture of the ED has been that substance use disorders are non-emergent conditions better addressed outside the ED where resources are less constrained. This study, its rapid funding mechanism, and accelerated timeline origi...
Background
Existing implementation measures developed in high-income countries may have limited appropriateness for use within low- and middle-income countries (LMIC). In response, researchers at Johns Hopkins University began developing the Mental Health Implementation Science Tools (mhIST) in 2013 to assess priority implementation determinants an...
Background
Existing implementation measures developed in high-income countries may have limited appropriateness for use within low- and middle-income countries (LMIC). In response, researchers at Johns Hopkins University began developing the Mental Health Implementation Science Tools (mhIST) in 2013 to assess priority implementation determinants an...
Depression and alcohol use disorder (AUD) greatly contribute to the burden of disease worldwide, and have large impact on Colombia’s population. In this study, a qualitative analysis evaluates the implementation of a technology-supported model for screening, decision support, and digital therapy for depression and AUD in Colombian primary care clin...
BACKGROUND
Technology-based interventions (TBIs) (i.e., web-based and mobile interventions) have the potential to promote health equity in substance use disorder treatment (SUTx) for underrepresented groups (i.e., African Americans/Blacks, Hispanics/Latinx, and American Indians/Alaskan Natives) by removing barriers and increasing access to cultural...
Background:
Technology-based interventions (TBIs; ie, web-based and mobile interventions) have the potential to promote health equity in substance use treatment (SUTx) for underrepresented groups (people who identify as African American/Black, Hispanic/Latinx, and American Indian/Alaskan Native) by removing barriers and increasing access to cultur...
This study explored mediating pathways, moderating factors, and moderated mediation effects of a web-based, cognitive behavioral therapy (CBT) intervention for chronic pain patients with aberrant drug-related behavior (ADRB). In a 2-arm RCT, patients with chronic pain who screened positive for ADRB received treatment-as-usual (TAU, n = 55) or TAU p...
Background
New Hampshire (NH) ranked first for fentanyl- and all opioid-related overdose deaths per capita from 2014 to 2016 and third in 2017 with no rate reduction from the previous year relative to all other states in the US. In response to the opioid crisis in NH, Manchester Fire Department (MFD), the state's largest city fire department, launc...
This cross-sectional study examined the feasibility of using four different web-based strategies to recruit rural and urban adults who use opioids non-medically for a survey on opioid use disorder (OUD) treatment preferences, and compared the treatment preferences of rural versus urban participants. Preferences for medication for opioid use disorde...
Posttraumatic Stress Disorder (PTSD) and hazardous drinking are highly comorbid, and often more severe than PTSD or hazardous drinking alone. Integrated, web-based interventions for PTSD/hazardous drinking may increase access to care, but have demonstrated equivocal results in reducing PTSD and hazardous drinking. One factor that may explain treatm...
Introduction:
Access to healthcare services involves a complex dynamic, where mental health conditions are especially disadvantaged, due to multiple factors related to the context and the involved stakeholders. However, a characterisation of this phenomenon has not been carried out in Colombia, and this motivates the present study.
Objectives:
T...
Background:
Mental disorders are a major cause of the global burden of disease and significantly contribute to disability and death. This challenge is particularly evident in low- and middle-income countries (LMICs), where >85% of the world's population live. Latin America is one region comprising LMICs where the burden of mental disorders is high...
Since the beginning of the HIV epidemic, there have been more than 75 million cases. Currently, there about 1.2 million living with HIV in the USA. Despite current testing recommendations, test rates continue to be suboptimal. Investigators have studied the use of digital technology to promote HIV testing, especially among high-risk populations.
P...
Objective
Opioid Overdose Network is an effort to generalize and adapt an existing research data network, the Accrual to Clinical Trials (ACT) Network, to support design of trials for survivors of opioid overdoses presenting to emergency departments (ED). Four institutions (Medical University of South Carolina (MUSC), Dartmouth Medical School (DMS)...
Introduction:
Depression represents a major disease burden in Colombia. To better understand opportunities to improve access to mental healthcare in Colombia, a research team at Javeriana University conducted formative qualitative research to explore stakeholders' experiences with the integration of mental healthcare into the primary care system....
Introduction
People with mental health conditions frequently attend primary care centers, but these conditions are underdiagnosed and undertreated. The objective of this paper is to describe the model and the findings of the implementation of a technology-based model of care for depression and unhealthy alcohol use in primary care centers in Colomb...
Background
Stigma is a sociocultural barrier to accessing mental health services and prevents individuals with mental health disorders from receiving mental health care. The Ministry of Health and Social Protection of Colombia acknowledges that a great number of people with mental disorders do not seek medical aid due to stigma.
Objectives
Charact...
Objective
Assess the prevalence and types of digital technology use, as well as the extent to which patients use the internet and mobile devises. Evaluate the socioeconomic characteristics of patients and the possible relation to patterns of technology use in Colombia. Understand the nature of patient technology use in primary care for finding medi...
Background
Men who have sex with men (MSM) and individuals identifying as Black or Hispanic/Latino experience the largest burden of Human Immunodeficiency Virus (HIV) infection. The OraQuick In-Home HIV Test (OraSure Technologies©, Pennsylvania, USA) is the only HIV self-test approved by the US Food and Drug Administration. Self-testing can supplem...
Harmful alcohol use is a public health problem worldwide, contributing to an estimated 5.1% of the global burden of illness. Screening and addressing at-risk drinking in primary care settings is an empirically supported health care intervention strategy to help reduce the burden of alcohol-use problems. In preparation for introducing screening and...
Introduction
Social media use is growing in Latin America and is increasingly being used in innovative ways. This study sought to characterise the profile of social media users, among primary care patients in Colombia, and to assess predictors of their use of social media to search for health and mental health information (searching behaviour).
Me...
Context
Colombia passed Law 100 in 1993 with the goal of providing universal health care coverage, and by 2013, over 96% of the Colombian population had health insurance coverage. However, little is known about how health-related quality of life (HRQoL) and health literacy are related among those with the two most common types of health insurance c...
Objective
Analyse the relationship between the sociodemographic profile of the DIADA study participants and the rate of compliance with the follow-up assessments in the early stage of this project’s intervention for depression and unhealthy alcohol use offered within primary care.
Methods
A non-experimental quantitative analysis was conducted. The...
Because adolescents and emerging adults are frequently not offered HIV testing, and often decline tests when offered, we developed and tested a tablet-based intervention to increase HIV test rates among emergency department (ED) patients aged 13-24 years. Pediatric and adult ED patients in a high volume New York City hospital (N = 295) were randomi...
Depression is a prevalent disorder and leading cause of disability in Latin America, where the mental health treatment gap is still above 50%. We sought to synthesise and assess the quality of the evidence on the feasibility of mHealth-based interventions for depression in Latin America. We conducted a literature search of studies published in 2007...
As digital technology increasingly informs clinical trials, novel ways to collect study data in the natural field setting have the potential to enhance the richness of research data. Cocaine use in clinical trials is usually collected via self-report and/or urine drug screen results, both of which have limitations. This article examines the feasibi...
Resumen
Introducción
Las personas con enfermedades mentales son frecuentes en atención primaria, pero son subdiagnosticadas y poco tratadas. El objetivo de este trabajo es describir un modelo para depresión y uso riesgoso de alcohol y los resultados de su implementación en centros de atención primaria en Colombia.
Métodos
Entre febrero de 2018 y...
Resumen
Introducción
El acceso a servicios de salud implica una dinámica compleja, donde las condiciones de salud mental se ven especialmente desfavorecidas, debido a múltiples factores relacionados con el contexto y los actores involucrados. Sin embargo, en Colombia no se ha caracterizado este fenómeno, lo cual motiva el presente estudio.
Objeti...
The EXIT-CJS (N = 1005) multisite open-label randomized controlled trial will compare retention and effectiveness of extended-release buprenorphine (XR-B) vs. extended-release naltrexone (XR-NTX) to treat opioid use disorder (OUD) among criminal justice system (CJS)-involved adults in six U.S. locales (New Jersey, New York City, Delaware, Oregon, C...
Technological advances have increased the prevalence of intensive longitudinal data as well as statistical techniques appropriate for these data, such as dynamic structural equation modeling (DSEM). Intensive longitudinal designs often investigate constructs related to affect or mood and do so with multiple item scales. However, applications of int...
Resumen
Objetivo
Evaluar la relación entre las características sociodemográficas de los participantes del proyecto DIADA y su tasa de cumplimiento al seguimiento en la fase inicial de la intervención en atención primaria para depresión y consumo riesgoso del alcohol.
Métodos
Se llevó a cabo un análisis cuantitativo no experimental. Se utilizaron...
Resumen
Introducción
La depresión representa una importante carga de enfermedad en Colombia. Para comprender mejor las oportunidades para mejorar el acceso a la atención de la salud mental en Colombia, un equipo de investigación de la Universidad Javeriana realizó una investigación cualitativa formativa para explorar las experiencias de las partes...
Resumen
Introducción
El uso de las redes sociales está creciendo en América Latina y de manera cada vez más innovadora. Este estudio busca caracterizar el perfil de los usuarios de las redes sociales entre los pacientes de atención primaria en Colombia y evaluar los predictores de utilización de las redes sociales para buscar información de salud...
Background
Prescription opioid (PO) use is common among adolescents in the United States. Despite recent declines from unprecedented peaks in adolescent PO use (eg, in 2012-2013), there is seemingly paradoxical evidence that PO-related consequences (eg, opioid use disorder and overdoses) are increasing. These trends and their possible consequences...
Resumen
Contexto
Colombia emitió la Ley 100 en 1993, con el objetivo de proveer un cubrimiento de salud para toda la población, y para el año 2013, más del 96% de la población colombiana tenía cubrimiento en salud. No obstante, es poca la evidencia sobre cómo la calidad de vida relacionada con la salud (CVRS) y la alfabetización en salud se relaci...
Resumen
Contexto
El estigma hacia la salud mental impide que personas con enfermedad mental accedan a servicios de salud mental y se beneficien de un manejo médico integral. El Ministerio de Salud y Protección Social de Colombia reconoce que personas con enfermedad mental no consultan al médico por varias razones, entre esas el estigma.
Objetivo...
Digital health, broadly defined as applying technology to better understand health behavior and offer healthcare resources, has shown promise in improving the treatment of substance use disorders (SUDs) worldwide. Relatively few individuals seek and receive SUD treatment due to factors such as lack of access and stigma; however, digital health inte...
Background
Few primary care patients are screened for substance use. As part of a phased feasibility study examining the implementation of electronic health record-integrated screening with the Tobacco, Alcohol, and Prescription Medication Screening (TAPS) Tool and clinical decision support (CDS) in rural primary care clinics, focus groups were con...
Objectives:
To evaluate the safety and efficacy of a digital therapeutic in treatment-seeking individuals with opioid use disorder (OUD) in an analysis of randomized clinical trial (RCT) data (ClinicalTrials.gov identifier: NCT00929253).
Methods:
Secondary analysis of an RCT including 170 adults meeting DSM-IV criteria for OUD. Participants were r...
In 2015, we provided an overview of the use of digital technologies in clinical trials, both as a methodological tool and as a mechanism to deliver interventions. At that time, there was limited guidance and limited use of digital technologies in clinical research. However, since then smartphones have become ubiquitous and digital health technologi...
UNSTRUCTURED
Healthcare delivery is undergoing a rapid change from traditional processes towards the use of digital health interventions and personalized medicine. Hospitals and health care providers are introducing hospital information systems, electronic health records, and telemedicine solutions to create more efficient workflows in and beyond i...
Background:
Technology-based computational strategies that leverage social network site (SNS) data to detect substance use are promising screening tools but rely on the presence of sufficient data to detect risk if it is present. A better understanding of the association between substance use and SNS participation may inform the utility of these t...
Advances in digital technologies and data analytics have created unparalleled opportunities to assess and modify health behavior and thus accelerate the ability of science to understand and contribute to improved health behavior and health outcomes. Digital health data capture the richness and granularity of individuals’ behavior, the confluence of...
Digital technologies are rapidly changing how we understand and promote health. A robust and growing line of research has examined how digital health may enhance our understanding and treatment of addiction. This manuscript highlights innovations in the application of digital health approaches to addiction medicine, with a particular emphasis on ad...
BACKGROUND
Technology-based computational strategies that leverage social network site (SNS) data to detect substance use are promising screening tools but rely on the presence of sufficient data to detect risk if it is present. A better understanding of the association between substance use and SNS participation may inform the utility of these tec...
BACKGROUND
The majority of those living with human immunodeficiency virus (HIV) are men who have sex with men (MSM), and young, minority MSM account for more new HIV infections than any other group. HIV transmission can be reduced through detection and early treatment initiation or starting pre-exposure prophylaxis (PrEP), but rates of testing are...
Background
The majority of those living with HIV in the United States are men who have sex with men (MSM), and young, minority MSM account for more new HIV infections than any other group. HIV transmission can be reduced through detection and early treatment initiation or by starting pre-exposure prophylaxis (PrEP), but rates of testing are lower t...
Integration of behavioral health care into primary care can improve health and economic outcomes. This study adapted the Behavioral Health Integration in Medical Care (BHIMC) index to the Colombian context and assessed the baseline level of behavioral health integration in a sample of primary care organizations. The BHIMC was able to detect the cap...
Aims and method
This systematic review examines the effectiveness and cost-effectiveness of behavioural health integration into primary healthcare in the management of depression and unhealthy alcohol use in low- and middle-income countries. Following PRISMA guidelines, this review included research that studied patients aged ≥18 years with unhealt...
Aim:
Treatment for opioid use disorders has recently evolved to include long-acting injectable and implantable formulations of medications for opioid use disorder (MOUD). Incorporating patient preferences into treatment for substance use disorders is associated with increased motivation and treatment satisfaction. This study sought to assess treat...
Objective:
Depression and alcohol use disorder are among the most common causes of disability and death worldwide. Health care systems are seeking ways to leverage technology to screen, evaluate, and treat these conditions, because workforce interventions alone, particularly in low- and middle-income countries, are insufficient. This article repor...
